Note: The information provided in this blog is through my experience as a Certified Telehealth Therapist, personal research, and intention of knowledge sharing. One should verify it before performing any Telehealth session.
We all are facing unprecedented times, for which we were never prepared. But even in these crises, as they say, “the show must go on!”
Telehealth is one such way where we, as physical therapists, can continue to care for our patients while we continue to maintain health safety measures for COVID-19 as recommended by WHO.
What is Telehealth?
As the name suggests, Telehealth is a digital way of remotely communicating and providing health care by performing evaluation and management for patients. This enables us, as therapists, to continue patient care by virtually dictating problem specific exercises and relying on patients' judgement to understand their pain and limitations. It demands a therapist’s creativity to patiently understand the functional inabilities of a patient and customize a plan of care for them in the best language understood.
Who are the Audience?
While anyone can be treated through Telehealth, using your expertise, recognize red flags and determine who should not be offered Virtual rehabilitation and should be treated in clinic instead. Telehealth has been proven to be effective in managing sub-acute postoperative patients, correcting posture and functional movements, ergonomic assessment for desk setups and home assessment for safety.
How is it performed?
Telehealth or Virtual rehabilitation is performed on a secured, HIPAA compliant platform, through a Ipad/laptop or a smartphone. Duration of which can be pre-agreed upon (between the therapists and/or managing team and the patient). It can be as short as 15 mins upto an hour long session or even more if justified! These sessions can be performed remotely from home (right now, since we are in lockdown), office, or anywhere else as long as you have a strong internet connection.
With all the Telehealth sessions I have been doing, I would recommend having enough space to demonstrate exercises since that's your strongest tool in rehabilitation.
How to choose a Platform:
Besides a secured and HIPAA compliant application, there are other factors to look for while deciding which platform to choose. For instance, exercise videos and images, expense, and additional features. There are various paid and free versions of these platforms out there, namely, Blue Jay, Doxy, Phzio, PT live etc. (Make sure to explore every feature they offer). Due to the need of the hour, many general video conferencing applications like Facetime and Hangouts are being used and have come up with new versions. For Eg: Zoom offers a healthcare version.
Before you perform Telehealth:
For treating patients within your state, assure if telehealth is within your scope of practice and for out of state patients, confirm how licensing works with the state board.
Irrespective of which platform you are using, make sure you have a clear communication with your patient for scheduling the appointment. Specify the date and time well and get a written confirmation through a scheduler or email, which you can revisit. Along with a confirmed date and time, send instructions to log in and how to use the platform and all that is needed for the appointment to go smoothly. Verbal consent from the patient is essential before you begin the appointment.
After you perform Telehealth:
Summarize your visit at the end of the call and use a descriptive language (Remember, your words are your power in your physical absence) to motivate them for continuing their exercises by themselves. End the call by reiterating or scheduling the next appointment.
How Payment works:
Commercial payers: With new problems, we have new situations and so, new regulations have been updated. But due to constant changes, it is recommended to discuss with your commercial payers and insurance agencies for coverage rules for Telehealth.
Medicare: As of a recent update, Medicare will only reimburse for e-visits and not for Telehealth.
Review these websites to understand the billing considerations and codes: https://codingintel.com/cpt-codes-online-digital-evaluation-and-management-services/
Cash pay: With predetermined agreement, It may be the quickest option right now. There's always an option for reimbursement from the payers. Strong documentation and consent is recommended.
With every passing minute, this crisis is making us witness situations like we have never before. Each day, we are learning new ways to help patients achieve better quality of life. For all that's worth, Telehealth may completely prove to be a boon to our field of Physical Therapy. Let's come together to develop this contemporary skill and make rehabilitation more accessible.
Don’t hesitate to ask questions and reach out by commenting below, it might only help spread more awareness.
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